Swiss border resident: LAMal or French health insurance

Cross-border workers who reside in France and work in Switzerland choose between Swiss health insurance (LAMal) and French health insurance. This is known as the "right of option." This choice must be exercised within three months of starting work in Switzerland or transferring residence to France. The FOPH (Federal Office of Public Health) form is for Swiss or EU citizens residing in France; for other nationalities, the situation should be verified with the FOPH or the cantonal health authority. After this period, cross-border workers are automatically enrolled in Swiss health insurance. The choice is final, unless a new event occurs: resuming work in Switzerland, moving to France, or retiring from the Swiss system alone.

This page describes the mechanism according to Cleiss and the Swiss Federal Office of Public Health (FOPH). It does not compare costs or benefits, and does not provide any bonuses: the pages read do not publish any.

The two systems between which one chooses

The starting point, according to the Federal Office of Public Health (FOPH), is that people domiciled abroad who work in Switzerland "must, in principle, take out health insurance in Switzerland," with possible exceptions depending on their country of residence and nationality. The form, as its title indicates, is intended for "Swiss or EU nationals residing in France" who work in Switzerland or receive only a Swiss pension; other cases are not addressed here. Switzerland has concluded specific agreements with Germany, Austria, France, and Italy. For France, the FOPH cites the agreement of July 7, 2016.

The waiting period: three months, then automatic affiliation

The Cleiss (French Centre for Social Security Information) states: "You have a period of 3 months from the date you began working in Switzerland." The Cleiss FAQ specifies: "You have 3 months from the date you began working in Switzerland or from the date you transferred your residence to France." The FOPH (Federal Office of Public Health) form stipulates "a period of 3 months from the date you became registered with the Swiss social security system," or from the date you established your residence in France. The FOPH mentions that an exemption request must be submitted "within three months" to the competent authority in the canton where you work.

Without a choice within the timeframe: "After this 3-month period, you will be automatically enrolled with Swiss health insurance" (Cleiss). The FOPH form refers to "automatic enrollment with a Swiss health insurer.".

The FOPH adds that "the tacit exercise of the right of option is not legally valid." It links this statement to a 2015 ruling by the Federal Supreme Court. The page does not specify what this changes in practice for each situation: the choice is made via the form, not simply through behavior.

A final choice, with exceptions

The Cleiss is clear: "the right of option can only be exercised once and is irrevocable." The FOPH form reiterates this rule: the choice cannot be changed "subject to a new event triggering its exercise.".

The triggering events cited by Cleiss and FOPH:

• taking up or resuming activity in Switzerland (Cleiss gives the example of a resumption after a period of unemployment); ;
• the transfer of residence or taking up residence in France; ;
• the transition to retirement under the only Swiss pension scheme.

According to the Cleiss FAQ, changes in civil status (marriage, divorce) and changes in family composition (birth or death) do not allow the choice to be reversed.

How to exercise the option

1. Complete the "Choice of health insurance system" form (January 2024 version on the FOPH website).
2. Have it received by the CPAM of the place of residence: section 6 of the form is reserved for it, in all cases.
3. It must be submitted within three months to the competent cantonal body in the canton of employment (Cleiss and FOPH). Those receiving a Swiss pension should write to the Joint Institution LAMal.

The sections of the form are divided between the insured (personal data, activity, family members, choice of scheme), the CPAM (reception) and, where applicable, the Swiss authority (exemption).

The family without activity

The Cleiss states: "This choice also applies to family members who are not employed." The FOPH form includes a section for non-working family members. The two texts have not been compared line by line for this page: for a spouse or children, please refer to the form and the cantonal authority before signing. According to the Cleiss FAQ, family members without employment or a Swiss pension cannot exercise this option themselves, and their coverage, if they reside in France, depends on the option you have chosen.

The contribution, without a figure

With Swiss insurance, "you contribute to Swiss health insurance" (Cleiss). With the French system, you are "covered by the French system upon payment of a contribution." Cleiss refers users to the Urssaf simulator to estimate the amount. None of the pages reviewed provide a rate or premium.

A tax effect that needs to be checked

The French tax administration's notice 2041-GG (for 2025 income) explains that the CSG (General Social Contribution) and CRDS (Contribution to the Repayment of the Social Debt) are due on foreign-source employment income of individuals domiciled in France who are "covered, in any capacity whatsoever, by a mandatory French health insurance scheme," provided that a tax treaty does not preclude taxation in France. The rates cited are 9.2% for CSG and 0.5% for CRDS, on a base reduced by a standard deduction of 1.75%. The notice does not include any specific information for Swiss cross-border workers. Therefore, this page does not indicate whether these contributions apply to your salary: this is a point to verify before opting in.

LAMal right of option: numerical example (fictitious profile)

Situation. Sophie lives in France, is married, and has two children who are not employed; her spouse is also unemployed (hypothetical situation). She starts a permanent contract in Switzerland on February 1, 2027.

Issue. She must choose a health insurance system for herself and, according to Cleiss, this choice also applies to her inactive family.

Strategy. Remember the three-month rule from the start of activity and make the form a calendar deadline.

Result (CALCULATION). Three months after February 1, 2027, we arrive at May 1, 2027. As a precaution, we'll use the day before, April 30, 2027, as a reference point, which is 88 days after the start of employment. The sources consulted don't specify whether the last relevant day is April 30 or May 1; the exact date will be confirmed with the cantonal authority. This choice concerns four people (Sophie, her spouse, and her two children), subject to the specific requirements of the form for each individual.

This profile is fictitious. No costs are compared.

What this page doesn't say

• Premiums, contribution rates and comparative cost of the two systems.
• The differences in reimbursement or benefits between the two systems.
• The fate of each family member (active or not, depending on age).
• The procedure for former optants or transitional cases of the 2016 agreement.

What changes depending on your situation

• The date you started your activity : it sets the starting point for the three months.
• Your canton of employment : it is his cantonal body that receives the form.
• The composition of your household : non-working spouse, children, or active member.
• Your tax status and the way your salary is taxed, which can interact with the CSG and CRDS.
• A triggering event Coming soon: resumption of activity, moving to France, retirement.

The rule depends on your situation. No results are guaranteed.